Going public: Confirmed Salmonella cases in Texas

For all those public health and industry types who are reluctant to go public in the absence of definitive data, Dalhart, Texas, says, you suck.

powell.food.safety.going.publicPeople are entitled to information that can affect their health. And with the growth of social media, word is going to get out anyway.

My High Plains reports that Coon Memorial Hospital tells us three cases of salmonella in Dalhart were reported to the state last week.

At this point, how those people contracted the illness is unknown, and the cases are under investigation.

We spoke with nurses from the high school, junior high and elementary school in Dalhart, and they tell us they’ve seen no cases of salmonella at their schools.

We also heard from the state health department and a nurse from Coon Memorial Hospital who tells us cases of salmonella are fairly common.

ER Manager at Coon Memorial Kelly Galloway says,  “it’s just like anything else.  It comes in cycles, just like the flu or RSV, sometimes we’ll see it once a year, sometimes we won’t see it for a couple of years.  It’s cyclic. “

Biggest PR screw-up in NZ for 2014? Bad lettuce

The handling of a food poisoning scare involving carrots and lettuce has been deemed the biggest public relations challenge this year by a Wellington PR firm.

lettuce.skull.e.coli.O145The handling of the Yersinia pseudotuberculosis issue by the Ministry for Primary Industries beat the closure of regional flight routes by Air New Zealand and Roger Sutton’s resignation by the State Services Commission to make the top of the list.

“In a year of dirty politics, what really concerned New Zealanders most was dirty lettuce and carrots,” BlacklandPR director Mark Blackham said.

“Everyone had these vegetables in our fridges, yet no one in authority could say for some time whether they were a health threat.

Millions of people were affected and little information is a recipe for fear, rumours and anger.”

U.K. health authority’s lack of public information questioned in E. coli O55 outbreak

Doug chronicled one of the issues that public health folks deal with regularly – what to tell the public about investigations into outbreaks, and when – for his most recent column for Texas A&M’s Center for Food Safety,

Go public too early, and make a mistake, and a corporation or industry’s reputation could unduly suffer. Go public too late, and individuals and businesses may be denied critical information they could use to protect public health.

An E. coli O55 outbreak that has led to at least 11 illnesses has family members challenging the unwritten dogma of when health officials go public, according to the Bournemouth Daily Echo.Screen Shot 2014-11-28 at 5.14.57 PM

Victims of the E coli outbreak have criticised Public Health England for not doing more to publicise the risks of the bug.  PHE stressed it had thoroughly investigated each and every case but had not been able to find any common source between the cases in July and August. It said it had not told any of the victims their cases were closed but that activity would have slowed because of the lack of any common factor between cases.

But victims and relatives are still unhappy with the way the PHE has handled the issue. The grandfather of a three-year-old Blandford girl, currently battling E coli in Southampton General Hospital, said: “Why does it need a newspaper to get involved for PHE to do something? “They could have let people know about the symptoms and what to look out for weeks or months ago.”

He said his granddaughter had been in theatre for an operation on Wednesday and was now back on dialysis. “We are just keeping everything crossed at the moment. It’s so heartbreaking to walk in and see her hooked up to all these machines.”

Gabrielle Archer, whose son Isaac Mortlock was among the first victims of the current outbreak, said: “I’m devastated to hear that these other children are now suffering and going through the daily blood tests and dialysis that Isaac had to go through. “I feel that perhaps had Public Health England taken this case a bit more seriously that might not have happened.”

A spokesperson for PHE said they had been proactive but said this did not necessarily mean engaging with the media.

In a related story, the mother of one of the children tragically impacted by the outbreak detailed the devastating effects of E. coli O55

These horrifying images of 21-month old Freddy Osborne seriously ill with E coli show just how serious the bug can be. Mum Charlotte Fudge, 25, allowed the Echo to print the picture of Freddy in intensive care to raise awareness of the illness, which since July has affected 10 people who are either residents in Dorset or visited the county. It’s believed Freddy, of Bournemouth, was the first to contract the disease in July and spent a month in Southampton General Hospital, two weeks of which he spent in paediatric intensive care. He needed four blood transfusions, one platelet transfusion and had four seizures due to swelling on the brain. One of these lasted for four hours and left him blind for 10 days. Following this seizure, he was put into a coma for six days as it was too dangerous for him to try and breathe by himself. He had fluid on his heart causing his heart rate to go up to 202 beats per minute and he ended up suffering from morphine withdrawal.  

Foodborne outbreaks: Learning opportunities, regardless of uncertainty, and should not be hidden

My latest column for Texas A&M’s Center for Food Safety:

powell.food.safety.going.publicThere was this one time, about 32 years ago, I was sitting in the kitchen with the mother of my university girlfriend.

She was peeling potatoes for boiling and mashing, and I smugly asked, why are you wasting so much potato?

“Because I don’t have all bloody day and if you’re so concerned, get off your bloody ass and bloody-well help.”

I’ve cooked ever since.

But what the mom and I didn’t know was that those potato skins could be contaminated with nasties like E. coli O157.

Potatoes, carrots, leeks, they’re grown in soil, and poop has various ways of getting into soil, so peeling potatoes should be like handling raw meat – you never bloody-well know what is contaminated and what isn’t.

Be the bug, follow the bug.

The folks at the U.K. Food Standards Agency, whose idea of science-based verification is to cook meat until it is piping hot, have apparently decided that E. coli O157:H7 – the dangerous kind – found on or in leeks, is the consumers’ responsibility.

Almost two months after revealing 250 people were sickened and one died with E. coli O157:H7 phage-type 8 over the previous eight months in 2011, linked to people handling loose raw leeks and potatoes in their homes, FSA decided to launch a campaign reminding people to wash raw vegetables to help minimize the risk of food poisoning.

leek_washNo information on how those 250 became sick and no information on farming and packing practices that may have led to such a massive contamination that so many people got sick, no information on anything: just advice to wash things thoroughly so that contamination can be spread throughout the kitchen.

This outbreak combines two of the central themes of conflict and public trust in all things food: when to go public, and blaming consumers.

Often during an outbreak of foodborne illness there are health officials who have data indicating that there is a risk, prior to the public (although social media is changing that equation).

During the lag period between the first public health signal and some release of public information, there are decision-makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions.

On June 2, 2008, the U.S. Centers for Disease Control and Prevention (CDC) announced that it was investigating an ongoing multistate outbreak of human Salmonella serotype Saintpaul infections. CDC identified the consumption of raw tomatoes as the likely source of the illnesses in at least two states. By the time the outbreak was officially declared over on August 28, 2008, 1,442 people had been reported infected, at least 286 people had been hospitalized, and the infection may have contributed to two deaths. Despite the early identification of tomatoes as a potential pathogen source, jalapeño peppers were subsequently identified as the major source, with some implication of serrano peppers as well.

Was the public advisory to avoid raw tomatoes issued too early in the outbreak investigation, despite its intent as a control measure?  Some, including the Florida Tomato Committee may believe so, considering the outcome of the investigation and the substantial impact on the agriculture sector. The estimated economic cost to the tomato industry was more than $100 million in Florida and close to $14 million in Georgia.

In a 1999 news article about a Listeria monocytogenes outbreak, CDC foodborne illness epidemiologist Paul Mead summed up the conundrum that health officials face when reviewing preliminary data during an outbreak investigation: “Food safety recalls are always either too early or too late. If you’re right, it’s always too late. If you’re wrong, it’s always too early.”  Go public too early, and make a mistake, and a corporation or industry’s reputation could unduly suffer. Go public too late, and individuals and businesses may be denied critical information they could use to protect public health.

This balancing act was most recently on display in New Zealand, following 170 confirmed cases of Yersinia pseudotuberculosis and a further 59 suspected but not confirmed cases of infection, apparently linked to lettuce.

By early Oct. 2014, enough people were sick that Food Safety Minister Jo Goodhew was compelled to finger Pams Fresh Mesclun Salad Lettuce and Pams Fresh Express Lettuce, while stressing the list was not initially released because it showed no definitive cause for the illness.

This is a disturbing trend, in that people are demanding microbiological proof when none exists – epidemiology remains a powerful and preventative public health tool.

Canterbury medical officer of health Dr Alistair Humphrey said a draft report from Environmental Science and Research (ESR) made available the previous week identified lettuce and carrots from a particular supermarket chain as the source.

“Everybody involved in this work, including MPI, ESR, all the public health units and the Ministry of Health, have seen the results of the ESR study, which is quite clear. It is unequivocal and it does name the types of food that have led to this problem and it also names one particular product,” Humphrey told Radio New Zealand.

He claimed MPI asked public health officials to keep the name of the supermarket and the products involved a secret, but he decided to name the vegetables to protect the public.

“[MPI] felt they should work with the industry rather than naming the foods but, of course, that leaves the New Zealand public slightly at risk, in my view.”

Bureaucrats are terrified of discussions of risk.

Within days of the public announcement, dozens of N.Z. Herald readers affected by the illness sent in messages describing what they went through, with many saying they were left bedridden, drowsy and debilitated.

But then the backpedaling started, portraying Living Farms, the producers of Pam’s greens, as victims of a zealous media, and by Nov., epidemiology was dumped in favor of “no Yersinia pseudotuberculosis was detected in any samples.”

Yet internal e-mails under the Official Information Act show the Ministry for Primary Industries (MPI) was mindful of balancing the risk of further illness against the risk of panicking the public and a loss of trust in the food supply chain.

An email from MPI, dated 1 October, said it considered “there will be greater ongoing positive effect and influence, with lesser risk of negative results, by managing the food safety hazard at the most likely source, ie: with industry.”

public.healthMPI had been visiting farms and retailers to try and pinpoint the source of the bug.

The documents also showed MPI believed the best it could do was inform the public to wash all fruit and vegetables as a precaution.

But, in an email dated 1 October, MPI said it was likely that the suspected vegetables were contaminated with the bacteria internally, rather than just on the surface: “Meaning that washing of the produce by consumers will not afford protection from illness.” This information was not passed on to consumers.

I don’t envy anyone facing bloody accusations. Growers and others would be better served if there were clear, publicly available guidelines for when to go public about foodborne illness. And don’t bloody-well blame consumers unless it is warranted.

Dr. Douglas Powell is a former professor of food safety who shops, cooks and ferments from his home in Brisbane, Australia.

 DISCLAIMER: The views and opinions expressed in this blog are those of the original creator and do not necessarily represent that of the Texas A&M Center for Food Safety or Texas A&M University. 

130 people sickened from Salmonella in beef in Denmark; no one told for 40 days

Danish supermarket chain Dansk Supermarked has suspended all trade with domestic supplier Skare Meat Packers (SMP) following the discovery that salmonella-infected ground beef was delivered by SMP to the retailer’s Netto discount grocery stores in June.

skare.denmarkLast month, it was revealed that up to 130 people, including a three-year-old boy, may have gotten ill from salmonella in ground beef in an outbreak that was kept hidden from the public until now.

Metroxpress obtained access to documents that reveal that ground beef infected with multi resistant salmonella was sold by the Vejen-based food company Skare in June.

According to earlier reports, Skare delivered the beef to stores on June 13th but did not recall it as required by law when an analysis the following day found the presence of salmonella.

According to the Danish State Serum Institute (SSI), 19 people, including the three-year-old, reported being ill just days later. Beyond the 19 registered cases, SSI estimates that up to 130 people may have been sickened by the tainted meat.

“Six of the 19 were so sick that they were hospitalised,” SSI’s Kåre Mølbak told Metroxpress.

The Danish Veterinary and Food Administration (Fødevarestrylsen) first traced the infection to Skare a full 40 days after the meat was sent to stores, but the food authorities did not require a recall.

ffff_0Neither Skare or Fødevarestrylsen will tell consumers where the meat was sold.

“This is confidential information, the release of which would cause considerable economic harm to the company,” Fødevarestrylsen wrote, according to Metroxpress.

Food safety expert Orla Zinck called the authorities’ decision “a scandal of unimaginable proportions.”

“Fødevarestrylsen’s acts are a danger to consumers’ health when it, out of consideration for Skare’s revenues, fails to recall dangerous meat and on top of that hides where it was sold,” Zinck told Metroxpress.

Fødevarestrylsen has also faced criticism for its slow reaction to a listeria outbreak that has caused 16 deaths.

Salmonella in beef; Danish officials kept yet another food scandal secret

Up to 130 people, including a three-year-old boy, may have gotten ill from salmonella in ground beef in an outbreak that was kept hidden from the public until now.

skare.denmarkMetroxpress obtained access to documents that reveal that ground beef infected with multi resistant salmonella was sold by the Vejen-based food company Skare in June.

Skare delivered the beef to stores on June 13th but did not recall it as required by law when an analysis the following day found the presence of salmonella.

According to the Danish State Serum Institute (SSI), 19 people, including the three-year-old, reported being ill just days later. Beyond the 19 registered cases, SSI estimates that up to 130 people may have been sickened by the tainted meat.

“Six of the 19 were so sick that they were hospitalised,” SSI’s Kåre Mølbak told Metroxpress.

The Danish Veterinary and Food Administration (Fødevarestrylsen) first traced the infection to Skare a full 40 days after the meat was sent to stores, but the food authorities did not require a recall.

Neither Skare or Fødevarestrylsen will tell consumers where the meat was sold.

“This is confidential information, the release of which would cause considerable economic harm to the company,” Fødevarestrylsen wrote, according to Metroxpress.

Food safety expert Orla Zinck called the authorities’ decision “a scandal of unimaginable proportions.”

“Fødevarestrylsen’s acts are a danger to consumers’ health when it, out of consideration for Skare’s revenues, fails to recall dangerous meat and on top of that hides where it was sold,” Zinck told Metroxpress.

Fødevarestrylsen has also faced criticism for its slow reaction to a listeria outbreak that has caused 16 deaths.

Going public: Salmonella, tomatoes (not) and court

Summer 2008 was adventurous for us: Amy was pregnant, we were in Quebec, and I was handling endless media calls about Salmonella in tomatoes that sickened at least 851 people in the U.S., including a sorta creepy middle-of-the-night chat fest for some radio station.

tomato.outbreakoffdaTurns out it was probably jalapeño peppers.

Tomato growers lost millions and decided to sue the U.S. government for going public prematurely.

Growers and others would be better served if there were clear, publicly available guidelines for when to go public about foodborne illness.

As reported by Michael Doyle of the Fresno Bee, a federal court has rejected the potentially far-reaching claims of Florida tomato growers who say they lost business because of Food and Drug Administration warnings.

The ruling unsettles numerous growers, who collectively lost several hundred million dollars following FDA food safety warnings in 2008 that proved erroneous. The ruling also curtails other growers tempted to base similar challenges on the constitutional requirement that the government pay compensation for taking property.

tomato.sign.jpg“Advisory pronouncements, even those with significant financial impact on the marketplace, are not enough to effect a taking of property under the Fifth Amendment,” U.S. Court of Federal Claims Senior Judge Lynn J. Bush stated.

In a 13-page decision quietly issued Thursday, Bush concluded that “although a wide range of government actions may give rise to regulatory takings,” these actions do not extend to “press releases and consumer advisories, by themselves.”

The Tallahassee, Fla.-based attorney representing the growers, M. Stephen Turner, said in an interview Friday that he will appeal. He likened the government’s actions to somebody who “stands in front of a house and says it’s infested with vermin,” thereby destroying property value.

The FDA had responded to an outbreak of salmonella-related illnesses in 2008, issuing warnings on June 3 and June 7 of that year linking the outbreak to certain types of tomatoes. The FDA also held a media briefing on June 13, opining that the “vast majority” of salmonella-tainted tomatoes was “very likely” from New Mexico and Florida.

Four days later, having concluded the disease outbreak was actually linked to imported serrano and jalapeno peppers, the FDA lifted its warning against tomatoes. In the meantime, though, “all or almost all of the value of plaintiffs’ perishable tomatoes was destroyed by the collapse in the market for tomatoes triggered by the FDA’s warnings,” Bush noted.

tomato.recallThe price of Georgia tomatoes in 2008 dropped to less than $4 per box from the usual $18 to $19, while some Florida growers were reportedly reduced to selling their crop for less than $1 per box.

Going public: anger over ‘lack of warning’ on E. coli at Irish beach

E. coli was detected in the water off of Bettystown beach, Co Meath, where families and young children have been swimming during the warm weather.

dp.beach.jun.13But locals are furious that the presence of the bug was not widely publicized before Wednesday, the hottest day of the year.

Meath County Council was criticized yesterday for failing to put up large notices and not having staff at Bettystown beach notifying people that the water had elevated levels of E. coli and enterococci bacteria.

However, Meath County Council said that within an hour of getting the results of tests on the water that it erected a notice at the entrance to the beach and put it on its website.

But this was criticized by parents and politicians who said signage wasn’t obvious.

One mother, whose children had been in the sea on Wednesday afternoon, said she spent “all night worrying” about them.

Going public: listeriosis in Austria: report of the National Reference Centre for 2013

In 2013, 33 invasive human listeriosis disease were registered in Austria, including two pregnancies. The 28-day mortality was 24% in 2013 (8 of 33). This high lethality and occasional serious permanent damage, require efforts listeriafor earliest possible detection of any food-borne outbreaks.

The example of an outbreak with a serovar 1/2b-Klon (2 cases in 2012 and 2 in the first half of 2013) shows that increased awareness as part of an outbreak investigation, when the causative source of infection can not be definitely proven, leads to increased preventative measures (something may be lost in translation).

18 sick with Salmonella; U. Sydney food outlet under investigation

Continuing with the theme of Australian foodborne illness silence, allegations of food poisoning have been made against a food outlet in the Wentworth-Jane Foss Russell Building area at the University of Sydney, prompting an investigation by local authorities.

Ada Lee of Honi Soit, a student media outlet, reports that in the last week of January during university holidays, professors, employees, and students epidemiology.WATER PUMP3_Page_4reported stomach sicknesses after consuming meals from the same food outlet on campus.

The food outlet in question has now been reported to authorities. The Sydney Local Health District (LHD) and NSW Food Authority are currently investigating the “likely cause” of 12 confirmed cases and six suspected cases of Salmonella infection, according to a Sydney LHD spokesperson.

USU CEO, Andrew Woodward, informed Honi Soit that the investigation has found Salmonella bacteria in one of the ingredients used in food preparation at the store. “However, we are awaiting confirmation that the strain of salmonella found in the cases matches the salmonella found in the [ingredient name omitted] served by [shop name omitted].”

Alex Mouzone, third-year, mature age, B. PESS student, spent almost a week in hospital suffering from salmonellosis. Mouzone believes his illness was caused by his lunch from the Wentworth-Jane Foss Russell area on Friday, 24 January. The next week, the outlet stopped selling the item Mouzone bought in response to requests from the USU.

The accused shop has been a USU tenant (distinct from a USU outlet) for 20 years. When assessing a store’s suitability for tenancy, an external, professional leasing agency looks at food safety history, business practice and customer service. “Based on the check, their 20 year association with the USU and their popularity with the campus community, [shop name omitted] was assessed as an appropriate tenant at each opportunity, i.e. at lease origination and lease renewal,” said Woodward.

An addendum to the story states: The Sydney Local Health District spoke to Honi Soit on the condition that the food outlet remains unnamed until the allegations are confirmed.

Sydney and NSW health types: epidemiology still works, and works much better than testing.